Notification of Privacy
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Effective: August 24, 2017
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Covered Entities Duties:
Home State Health Plan is a Covered Entity as defined and regulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Home State Health Plan is required by law to keep the privacy of your protected health information (PHI). We must give you this Notice of our legal duties and privacy practices related to your PHI, abide by the terms of the Notice that is currently in affect and notify you in the event of a breach of your unsecured PHI.
This Notice describes how we may use and disclose your PHI. It describes your rights to access, change and manage your PHI. It also states how to use your rights. All other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization.
Home State Health Plan reserves the right to change this Notice. We reserve the right to make the revised or changed Notice effective for your PHI we already have as well as any of your PHI we get in the future. Home State Health Plan will promptly revise and distribute this Notice whenever there is a material change to the uses and disclosures, your rights, our legal duties, or other privacy practices stated in the notice. We will make any revised Notices available on our website and in our Member Handbook. We will also mail you or email you a copy on request.
Internal Protections of Oral, Written and Electronic PHI:
Home State Health Plan protects your PHI. We have privacy and security processes to help.
These are some of the ways we protect your PHI.
- We train our staff to follow our privacy and security processes.
- We require our business associates to follow privacy and security processes.
- We keep our offices secure.
- We talk about your PHI only for a business reason with people who need to know.
- We keep your PHI secure when we send it or store it electronically.
- We use technology to keep the wrong people from accessing your PHI.
Permitted Uses and Disclosures of Your PHI:
The following is a list of how we may use or disclose your PHI without your permission or authorization:
- Treatment - We may use or disclose your PHI to a physician or other health care providers providing treatment to you, to coordinate your treatment among providers, or to assist us with prior authorization decisions related to your benefits.
- Payment - We may use and disclose your PHI to make benefit payments for the health care services provided to you. We may disclose your PHI to another health plan, a healthcare provider, or other entity subject to the federal Privacy Rules for their payment purposes. Payment activities may include processing claims, determining eligibility or coverage for claims, issuing premium billings, reviewing services for medical necessity, and performing utilization review of claims.
- HealthCare Operations - We may use and disclose your PHI to perform our healthcare operations. These activities may include:
- providing customer services,
- responding to complaints and appeals,
- providing case management and care coordination,
- conducting medical review of claims and
- other quality assessment improvement activities.
- In our health care operations, we may also disclose PHI to business associates with whom we have written agreements containing terms to protect the privacy of your PHI with these associates. We may disclose your PHI to another entity that is subject to the federal Privacy Rules and that has a relationship with you for its healthcare operations. This includes the following:
- quality assessment and improvement activities
- reviewing the competence or qualifications of healthcare professionals
- case management and care coordination, or
- detecting or preventing healthcare fraud and abuse.
Other Permitted or Required Disclosures of Your PHI:
- Appointment Reminders/Treatment Alternatives - We may use and disclose your PHI to remind you of an appointment for treatment and medical care with us or to provide you information about treatment alternatives or other health-related benefits and services, such as information on how to stop smoking or lose weight.
- As Required by Law - If federal, state, and/or local law requires a use or disclosure of your PHI, we may use or disclose your PHI information to the extent that the use or disclosure complies with the law and is limited to the requirements of the law. If two or more laws or regulations governing the same use or disclosure conflict, we will comply with the more restrictive laws or regulations.
- Public Health Activities - We may disclose your PHI to a public health authority to prevent or control disease, injury, or disability. We may disclose your PHI to the Food and Drug Administration (FDA) to ensure the quality, safety or effectiveness of products or services under the jurisdiction of the FDA.
- Victims of Abuse and Neglect - We may disclose your PHI to a local, state, or federal government authority, including social services or a protective services agency authorized by law to receive such reports if we have a reasonable belief of abuse, neglect or domestic violence.
- Judicial and Administrative Proceedings - We may disclose your PHI in judicial and administrative proceedings, as well as in response to:
- an order of a court,
- administrative tribunal
- discovery request,
- similar legal request.
- Law Enforcement - We may disclose your relevant PHI to law enforcement when required to do so, such as in response to:
- a court order,
- court-ordered warrant,
- summons issued by a judicial officer,
- grand jury subpoena.
We may also disclose your relevant PHI for the purposes of identifying or locating a suspect, fugitive, material witness, or missing person.
- Coroners, Medical Examiners and Funeral Directors - We may disclose your PHI to a coroner or medical examiner. This may be needed, for example, to determine a cause of death. We may also disclose your PHI to funeral directors, as needed, to carry out their duties.
- Organ, Eye and Tissue Donation - We may disclose your PHI to organ procurement organizations or entities engaging in the procurement, banking or transplantation of cadaveric organs, eyes or tissues.
- Threats to Health and Safety - We may use or disclose your PHI if we believe, in good faith, that it is needed to prevent or lessen a serious or imminent threat. This includes threats to the health or safety of a person or the public.
- Specialized Government Functions - If you are a member of U.S. Armed Forces, we may disclose your PHI as required by military command authorities. We may also disclose your PHI:
- to authorized federal officials for national security
- to intelligence activities
- the Department of State for medical suitability determinations; and
- for protective services of the President or other authorized persons
- Workers’ Compensation - We may disclose your PHI to comply with laws relating to workers’ compensation or other similar programs, established by law. These are programs that provide benefits for work-related injuries or illness without regard to fault.
- Emergency Situations - We may disclose your PHI in an emergency situation, or if you are unable to respond or are not present. This includes disclosure to:
- a family member,
- close personal friend
- authorized disaster relief agency; or
- any other person previously identified by you.
We will use professional judgment and experience to decide if the disclosure is in your best interests. If it is in your best interest, we will only disclose the PHI that is directly relevant to the person’s involvement in your care.
- Inmates - If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI to the correctional institution or law enforcement official, where such information is necessary for the institution to provide you with health care; to protect your health or safety; or the health or safety of others; or for the safety and security of the correctional institution.
- Research - In some cases, we may disclose your PHI to researchers when their clinical research study has been approved. They must have safeguards in place to ensure the privacy and protection of your PHI.
Uses and Disclosures of Your PHI That Require Your Written Authorization
We are required to obtain your written authorization to use or disclose your PHI, with few exceptions, for the following reasons:
- Sale of PHI - We will request your written approval before we make any disclosure that is deemed a sale of your PHI. A sale of your PHI means we are getting paid for disclosing the PHI in this manner.
- Marketing - We will request your written approval to use or disclose your PHI for marketing purposed with limited exceptions. For examples, when we have face-to-face marketing communications with you. Or, when we give promotional gifts of nominal value.
- Psychotherapy Notes. - We will request your written approval to use or disclose any of your psychotherapy notes that we may have on file with limited exception. For example, for certain treatment, payment or healthcare operation functions.
The following are your rights concerning your PHI. If you would like to use any of the following rights, please contact us. Our contact information is at the end of this Notice.
- Right to Revoke an Authorization - You may revoke your authorization at any time, the revocation of your authorization must be in writing. The revocation will be effective immediately, except to the extent that we have already taken actions in reliance of the authorization and before we received your written revocation.
- Right to Request Restrictions - You have the right to ask for restrictions on the use and disclosure of your PHI for treatment, payment or healthcare operations. You can also ask for disclosures to persons involved in your care or payment of your care. This includes family members or close friends. Your request should state the restrictions you are asking for. It should also say to whom the restriction applies. We are not required to agree to this request. If we agree, we will comply with your restriction request. We will not comply if the information is needed to provide you with emergency treatment. However, we will restrict the use or disclosure of PHI for payment or healthcare operations to a health plan when you have paid for the service or item out of pocket in full.
- Right to Request Confidential Communications - You have the right to ask that we communicate with you about your PHI in other ways or locations. This right only applies if the information could endanger you if it is not communicated in other ways or locations. You do not have to explain the reason for your request. However, you must state that the information could endanger you if the change is not made. We must work with your request if it is reasonable and states the other way or location where you PHI should be delivered.
- Right to Access and Receive a Copy of your PHI - You have the right, with limited exceptions, to look at or get copies of your PHI contained in a designated record set. You may ask that we give copies in a format other than photocopies. We will use the format you ask for unless we cannot reasonably do so. You must ask in writing to get access to your PHI. If we deny your request, we will give you a written explanation. We will let you know if the reasons for the denial can be reviewed. We will also let you know how to ask for a review or if the denial cannot be reviewed.
- Right to Change your PHI - You have the right to ask that we change your PHI if you believe it has wrong information. You must ask in writing. You must explain why the information should be changed. We may deny your request for certain reasons. For example, if we did not create the information you want changed and the creator of the PHI is able to perform the change. If we deny your request, we will provide you a written explanation. You may respond with a statement that you disagree with our decision. We will attach your statement to the PHI you ask that we change. If we accept your request to change the information, we will make reasonable efforts to inform others of the change. This includes people you name. We will also make the effort to include the changes in any future disclosures of that information.
- Right to Receive an Accounting of Disclosures - You have the right to get a list of times within the last 6 years in which we or our business associates disclosed your PHI. This would apply to disclosure for purposes of treatment, payment, healthcare operations, or disclosures you authorized and certain other activities. If you ask for this more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. We will give you more information on our fees at the time of your request
- Right to File a Complaint - If you feel your privacy rights have been violated or that we have violated our own privacy practices, you can file a complaint with us in writing or by phone using the contact information at the end of this Notice. You can also file a complaint with the Secretary of the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201 or calling 1-800-368-1019, (TTY: 1-866-788-4989) or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.
- Right to Receive a Copy of this Notice - You may ask for a copy of your Notice at any time. Use the contact information listed at the end of the Notice. If you get this Notice on our website or by email, you can request a paper copy of the Notice.
If you have any questions about this Notice, our privacy practices related to your PHI or how to exercise your rights you can contact us in writing. You can also contact us by phone. Use the contact information listed below.
Home State Health Plan
Attn: Privacy Official
16090 Swingley Ridge Road, Ste. 500
Chesterfield, Missouri 63017
1-855-694 (HOME) 4663
TDD/TTY 1-877-250-6113, Relay 711